The Venous Drainage of the Human Myocardium

ISBN-13: 9783540440178 / Angielski / Miękka / 2002 / 107 str.

William Warburton; M. Von Ludinghausen; Michael Von Ludinghausen

Opis

Enhanced performance,evaluation,and interpretation of the various forms ofcardi- ological diagnostic procedures and open-heart surgery, the achievement of a rapid improvement in the oxygen consumption ofhypoxic myocardium,and the salvage of viable but ischemic myocardium still appear to constitute the most important chal- lenges to modern medicine. Research on the vascular anatomyof the myocardium has mostlybeen focused on the coronary arteries and myocardial capillaries (von Liidinghausen 2002); by com- parison, the coronaryor cardiac venous systems have traditionally been neglected. A search through the literature of the mid-twentieth century onwards fails to reveal a detailed report on the anatomy and topography of the coronary sinus (CS) and its related veins (Smith 1962). In this area,new frontiers havebeencrossed through the useofthe technique ofCS catheterization,for instance for the purpose of: 1. Thevisualizationofthevenous partofcardiaccirculation [angiography,computed tomography (CT) I. Methods of visualization of the coronary venous drainage system using electron-beam CT and angiographical methods have recently been presented by Schaffleret al. (2000) and Sun et al. (2002). 2. Electro-physiologicalstudyoftheatrialcomponentsoftheconductionsystem.The morphologyofaccessory pathways ofthe conduction system in the neighborhood of the CS, their diagnostics and surgical treatment have been investigated and discussed by Becker et al. (1978), Seally and Mikat (1983), Robinson et al. (1988), and Sun et al. (2002).

Spis treści

1 Introduction.- 1.1 Goal of CS Catheterization.- 1.2 Objective of the Study.- 2 The Organization of the Cardiac Venous Systems.- 2.1 The Greater (Major) Cardiac Venous System.- 2.2 The Smaller (Minor) Cardiac Venous System.- 2.3 The Compound Form of Cardiac Venous Vessels: Intramural Sinuses and Tunnels.- 3 Nomenclatur.- 3.1 English and Latin Versions.- 3.2 Abbreviations.- 3.3 Commonly Used Unofficial or Alternative Terms and Synonyms for the Cardiac Veins.- 4 Microanatomy of the Coronary Sinus.- 4.1 Anatomy, Position, and Topography.- 4.2 Surface Anatomy.- 4.3 Length and Shape.- 4.4 Diameter, Area of Cross-Section, Circumference, and Volume.- 4.5 Elevation, Curvature, and Ostial Angle.- 4.6 The Ostial Valve.- 4.7 Enlargement of the CS, Aneurysm of the CS.- 4.8 Enlargement of the CS Associated with Persistent Left Superior Vena Cava.- 4.9 Enlargement of the CS Associated with Ostial Occlusion.- 4.10 Duplication of the CS (Sinus Coronarius ‘Duplex’).- 4.11 Absence of the CS.- 5 The Myocardial Cover of the Coronary Sinus and Related Veins.- 5.1 The Myocardial Cover of the CS.- 5.1.1 Peculiarity.- 5.2 The Left (Distal) Boundary of the Myocardial Coat of the CS and the Myocardial Cuff of the Terminal GCV.- 5.2.1 The Myocardial Coat of the CS.- 5.2.2 The Myocardial Cuff of the Terminal GCV.- 5.3 The Right (Proximal) Boundary of the Myocardial Coat of the CS.- 5.4 Isolated Myocardial Belts in the Terminal Portions of Other Cardiac Veins.- 5.5 ‘Free’ Myocardial Cords in the Left Posterior Coronary Sulcus.- 5.6 The Proximal Origin of the CS and Its Landmarks.- 5.6.1 The OV Is the Only Exact Peripheral Landmark for the Origin of the CS.- 5.6.2 Clinical Significance of Accessory Myocardial Cuffs, Belts, and Cords.- 6 The Anatomy of the Veins Draining the Myocardium of Both Ventricles.- 6.1 The Ventricular Cardiac Veins in General.- 6.1.1 The Apical Venous Network.- 6.1.2 Venous Valves.- 6.1.3 Left and Right V entricular Veins.- 6.1.4 Left and Right Atrial Veins.- 6.2 Frequency and Distribution Pattern of the Tributaries of the CS.- 6.3 The Great Cardiac Vein and the Anterior Interventricular Vein.- 6.4 S-Shaped (Sigmoid) Course of the Great Cardiac Vein.- 6.5 Intramyocardial Course of, or Myocardial Bridge Over, the Subepicardial Veins.- 6.6 Aberrant Course of the Anterior Interventricular Part of the Great Cardiac Vein.- 6.7 The Ostial (Terminal) Valve of the Great Cardiac Vein.- 6.8 The Oblique Vein of the Left Atrium.- 6.9 The Posterior Interventricular Vein.- 6.9.1 Ostial Valves.- 6.10 The Septal Veins.- 6.10.1 Anterior and Posterior Territories of the Interventricular Septum.- 6.10.2 Left Superior Septal Vein.- 6.10.3 Anterior Septal Veins.- 6.10.4 Right Superior Septal Vein.- 6.10.5 Venous Valves (Astklappen).- 6.10.6 Venous Drainage of the AV Junction.- 6.11 The Posterior Vein(s) of the Left Ventricle.- 6.12 The Small Cardiac Vein.- 6.13 The Left Marginal Vein.- 6.14 The Right Marginal Vein.- 6.15 The Anterior Cardiac Veins.- 6.16 The Venous Drainage of the Papillary Muscles.- 6.17 The Ostial Valves of Cardiac Veins.- 6.18 The Relationships Between Cardiac Veins and Coronary Arteries.- 6.19 The Veins of the Visceral Serosa.- 6.20 Venous Anastomoses.- 6.21 The Veins of the Vasa Vasorum of the Coronary Arteries, Aorta Ascendens and Pulmonary Trunk.- 7 The Anatomy of Veins Draining the Myocardium of Both Atria.- 7.1 The Veins of the Left Atrium.- 7.1.1 Posterolateral Veins of the LA.- 7.1.2 Posterosuperior Veins of the LA.- 7.1.3 Anteroseptal and Posteroseptal Veins of the LA.- 7.1.4 Ostial Valves of the Anteroseptal and Posteroseptal Veins of the LA.- 7.1.5 Intramural Sinuses of the Atrial Walls.- 7.1.6 Extracardiac Intercommunications.- 7.2 The Veins of the Right Atrium.- 7.2.1 Small Right Atrial Veins.- 7.2.2 Venous Drainage of the SA Node.- 7.2.3 Venous Drainage of the AV Node and Bundle Area.- 7.2.4 Venous Tunnel or Sinus of the Right Atrium.- 7.2.5 The Ostia of the VTRA.- 7.2.6 Topographical Relationship of the VTRA.- 7.2.7 Explanation for the Existence of the VTRA.- 8 The Significance of the Coronary Sinus and Cardiac Veins in Cardiology.- 8.1 The Anatomical Basis for Reperfusion of the CS and Selected Cardiac Veins and Imaging of the Coronary Venous Drainage System Using CT.- 8.1.1 Purpose of Reperfusion Technique.- 8.1.2 Basis of CS Catheterization.- 8.1.3 Failure and Limitation ofCS Catheterization.- 8.1.4 Computed Tomography.- 8.1.5 Coronary Venography.- 8.1.6 The Significance of Ostial Valves.- 8.1.7 The Significance of the Smallest Cardiac.- 8.1.8 Concept of the Hydraulic System of the Intramural and Subendocardial Sinuses in the Cardiac Walls and in the Heart Chambers.- 8.2 Anatomical Peculiarities Supporting Venous Reperfusion via the CS.- 8.3 Anatomical Hindrances to Catheterization of the CS and of Cardiac Veins.- 8.3.1 The Ostial Valve of the IVC.- 8.3.2 Persistent Left SVC.- 8.3.3 Aneurysm of the RA, Aneurysm of the CS.- 8.3.4 Rigid Ostial Valves of the CS and GCV.- 8.3.5 Congenital Occlusion of the Atrial Ostium of the CS.- 8.3.6 Openings of the PIV and PVLV Near to the Atrial Ostium of the CS.- 8.3.7 The ACVs and the RMV Empty Directly into the RA.- 8.3.8 Opening of the PIV Directly into the RA.- 8.3.9 The Anterior Interventricular Artery Crosses over the GCV.- 8.3.10 Intramyocardial Course of the AIV.- 8.3.11 Uni- or Bicuspid Valves of the Anterior and Posterior Septal Veins.- 8.3.12 Ectopic Origin and Aberrant Course of the AIV.- 9 The Cardiac Venous System Seen Three-Dimensionally: An Arrangement of Veins Which Favors Reperfusion Efficacy.- 9.1 The Efficiency of Ostial Valves.- 9.2 Prospect.- 10 Summary.- References.

Blurb

The objective of this study is to present comprehensive morphological data, almost all of it is new, concerning the venous drainage of the myocardium via the coronary sinus and its related veins. This information is of great significance, not least for the sucessful coronary sinus catheterization and reperfusion of most, or single, cardiac veins.The author presents the three principal cardiac venous systems, the greater (major) cardiac venous, the smaller (minor) cardiac venous system, and the compound venous system. The work concludes with an evaluation of the many anatomical peculiarities and and hindrances with regard to the catheterization of the coronary sinus and the reperfusion of (selected) cardiac veins.